Disentanglement may be an ugly word, but as health policy, it could bring some beautiful results. If we want rational, safe and effective care, the first thing we have to do is get our doctors out of bed with the drug companies, and stop the sleazy flow of money and influence. No-one can make rational decisions about how to treat us when they are inebriated.
Despite the endless wave of scandals about doctors having their stethoscopes in the trough, drug money continues to lubricate the working lives of many medical professionals.
The scenes are as familiar as they are sickening: the daily visits from the pretty sales reps to the busy GP surgery; the so-called medical education events held at the nation’s top restaurants; the prestigious international scientific congresses that offer the opportunity for corporate propaganda about the sponsor’s latest medicine.
Perhaps most disturbing of all is the corruption of scientific evidence itself, as sponsored trials are rigged and results come out far more favourable than they should.
This means the “evidence” doctors base their decisions on is far too focused on drug solutions, relying on studies that overstate drug benefits, play down their harms, and marginalise alternative approaches. That biased scientific evidence is then trumpeted across the globe via one of the biggest marketing machines the world has ever seen.
There are many within the medical and scientific community who are outraged by the depth of this corruption, and want change. We are living through a window of opportunity for innovative policy-makers to try and clean up the sleaze. There are two small steps along this path, the first is disclosure and the second is disentanglement.
Several states in the US are already pushing health professionals to disclose the full extent of their relationships with drug companies. Australia could easily do the same. This would mean a doctor having to make details available to every patient of every gift, meal and trip received from their drug company mates. There are tentative moves towards this, but they will falter and die without the backing of strong regulation.
Second, there is an urgent need to start building a new world of disentangled medicine. This would be a world in which a patient would have faith that when their professional prescribed them a drug, it was the best decision based on the best evidence, rather than some shoddy misinformed act based on sophisticated sleazy marketing.
New taxes on the marketing budgets of pharmaceutical companies could expand the existing pots of public resources for independently run clinical trials, producing a viable new pool of reliable and trustworthy scientific evidence. Coupled with this will be new mechanisms for making sure this new evidence is made available to both health professionals and their patients in accessible formats.
Reformed medical education will produce a new breed of doctors who enthusiastically use this reliable new evidence, who refuse to see drug reps and who turn down the constant invitations to the wining and dining.
Such reforms could obviously apply to other corrupting influences apart from the pharmaceutical industry, including the corporations pushing devices and diagnostic tests.
Already small pockets of health professionals are showing the way forward, including Healthy Skepticism in Australia and the New York based No Free Lunch in the United States, which runs a “pen amnesty”. A doctor refusing to accept a drug company pen is not some quirky act of defiance. It’s the first small glimpse of a more rational safe and effective health system.